GIMBE 3rd International Conference of EvidenceBased Health Care Teachers and Developers Building Bri

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GIMBE3rd International Conference of
Evidence-BasedHealth Care Teachers and
DevelopersBuilding Bridges BetweenResearch and
Teachung

• Evidence-Based
• Economic Decisions

Prof. Dr. Franz Porzsolt Dr. Heike
Leonhardt-Huober Clinical Economics University
Hospital Ulm franz.porzsolt_at_medizin.uni-ulm.de
Institute of Clinical Economics e.V.
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Evidence-BasedEconomic Decisions

• Economic decisions
• The example of Lufthansa
• The hypothesis
• The model of breast cancer screening
• Summary

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Evidence-BasedEconomic Decisions

• Economic decisions
• Comparing costs and consequences of alternative
  ways of actions
• Example breast cancer screeningcosts disadvant
  agesconsequences advatages
• ways of actions /- mammography

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Evidence-BasedEconomic Decisions

• The example of Lufthansa
• Negative evidence for the usefulness of life
  vests
• No water, or too cold or too hard
• Replacement of live vests by more effective and
  more efficient measures is NOT accepted
• Must be something like PERCEIVED SAFETY

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Evidence-BasedEconomic Decisions

• The hypothesis
• Perceived safety is an important domain in our
  daily life
• Large amounts of money are spent to protect our
  properties, for safe to driving/flying
• Managers pay for health check ups to be on the
  safe side
• Diagnostic medicine spends billions to generate
  perceived safety
• Patient information leaflets are an example for
  perceived unsafety

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Evidence-BasedEconomic Decisions

• The model of breast cancer screening

Barratt et al, BMJ 2005
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Evidence-BasedEconomic Decisions

• Summary I
• Disadvantages
• 219 false positives
• 10 false negatives

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Evidence-BasedEconomic Decisions

• The model of breast cancer screening

Barratt et al, BMJ 2005
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Evidence-BasedEconomic Decisions

• Summary II
• Disadvantages
• 219 false positives
• 10 false negatives
• 13 cases of pseudo-disease

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Fig. 1 Survival benefit by mammography
21??? Of all patients? Of patients at
risk? Of screened patients at risk?
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• Fig. 2 When all women are considered who were
  included in a screening program only 1 of 100
  will benefit.

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• Fig.3 When in addition the risk of the subgroup
  is considered which was was used to calculate the
  risk, only 1 of 1000 will have a survival benefit

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Evidence-BasedEconomic Decisions

• Summary III
• Disadvantages
• 219 false positives
• 10 false negatives
• 13 cases of pseudo-disease
• Advatages
• 1 survival benefit

that's all we can offer?
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Evidence-BasedEconomic Decisions

• Summary III
• Disadvantages
• 219 false positives
• 10 false negatives
• 13 cases of pseudo-disease
• Advatages
• 1 survival benefit
• 967 patients with PERCEVED SAFETY

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Evidence-BasedEconomic Decisions

• Summary IV
• Perceived safety may be a new dimension providing
  evidence for the usefulness of health care
  services
• Project on Perceived Safety Perceived Health
  will be startet Nov.9th 2005 together with
• Manfred Müller, Head Flight Safety, Lufthansa
• Robert Kaplan, Dept Health Services, UCLA
• 20 academic institutions and companies
• EBHC developers interested in this type of
  outcomes research are invited to participate in
  the necessary discussion